MP44-11 PATIENT SELECTION AND OUTCOMES BETWEEN LOW AND HIGH VOLUME SURGEONS IN PERFORMANCE OF RADICAL PROSTATECTOMY IN THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE (MUSIC)

Abstract

INTRODUCTION AND OBJECTIVES: In Michigan, the American Cancer Society estimates 5,350 newly diagnosed prostate cancer (PCa) cases a year. Radical prostatectomy (RP) is commonly used to treat localized PCa. By comparing lower (<10 RPs per year) and higher (>10 RPs per year) volume surgeons, we aim to discern variation in patient selection and surgeon technique to identify avenues to improve functional outcomes. METHOD(S): The Michigan Urological Surgery Improvement Collaborative (MUSIC), a statewide quality improvement consortium of >250 diverse MI urologists, uses a web-based data registry to collect information regarding a patient's RP. In April 2014, MUSIC began a patient reported outcomes (PRO) program. RP patients completed validated surveys pre- and 3, 6, 12, and 24 months post-RP, and a goal was set to increase the social continence (0-1 pads per day) rate at 3-months post-RP. In this study, bivariate tests compared patient characteristics between lower and higher volume surgeons, and a mixed-effects logistic regression model determined the independent effect of volume on 3-month social continence. RESULT(S): The analysis included 2,704 patients treated by 108 RP surgeons (48 lower volume surgeons completing 202 RPs and 60 higher volume surgeons completing 2502 RPs). The social continence rate 3 months post-RP was 56% and 67% (p<0.001) for lower and higher volume surgeons, respectively. Lower volume surgeons were less likely to perform bilateral nerve sparing (46% vs 70%, p<0.001) and their patients had higher preoperative PSA (median 6.7 vs. 6.0, p=0.036). Other factors (BMI, race, clinical T stage, age) were not significantly different between volume groups. Higher volume surgeons' patients were more likely to reach social continence at 3 months post-RP (OR=1.81, p=0.006, Table). CONCLUSION(S): RP for localized PCa is a complex operation, and these data provide further evidence that all RP surgeons should participate in PRO. MUSIC PRO provides a framework to identify surgeon characteristics or techniques that may be useful in improving functional outcomes through activities such as skills workshops, video review, and mentoring. (Table Presented).